A nurse-led team at Johns Hopkins Hospital in Baltimore, Maryland, sought to reduce their average patient wait time of 49.7 minutes to no more than 30 minutes beyond the scheduled appointment time. To achieve this goal, the interprofessional team identified issues that occur prior to patients' appointments that contribute to same-day inefficiencies.

Inconsistent preparations for the next day's patient visits and lack of a structured process for prescreening patients for infusion visits resulted in variable wait times for ambulatory oncology patients at the National Cancer Institute (NCI)-designated cancer center, explained Mary Beth Collins, MSN, RN.

The researchers developed an ambulatory clinical evaluation (ACE) team, a group of experienced nurse clinicians and pharmacists who have broad disease and treatment expertise. Without a structured prescreening process, the pharmacy was reluctant to prepare infusion drugs in advance. The ACE team's objective was to ensure patients are ready for treatment, thereby allowing for medications to be prepared in advance.

With the support of the oncology medical director, a new rule was set that required treatment orders and notes to be submitted 48 hours in advance of patient appointments. Partnering with the patient's primary nurse, the nurse ACE team completed an extensive review of the treatment orders, notes, and laboratory test results prior to a patient's scheduled appointment. The ACE nurse calls the patient the day before his or her appointment to conduct an assessment for symptoms or toxicities that indicate precluding or modifying the scheduled treatment. The assessment is performed using a standardized, treatment-specific symptom checklist.

The pharmacy ACE team receives a list of those patients who met pre-established criteria for having their infusion drug prepared in advance. On review of the list, the pharmacy ACE team approves preparation of the drugs the evening before the scheduled infusion visits.

Use of the ACE program has reduced average wait time for patients to 32.7 minutes. In addition, the early assessment has reduced wasted doses when patients are ineligible for their treatment.

The researchers concluded that the ACE program has improved the treatment experience for pharmacy staff, nurses, and most importantly, for patients.

“The ACE program has created a standardized approach for preparing to treat patients. Inclusive of safety checks and high reliability principles, this innovative program has enhanced our workflows and ensured safe drug administration,” the researchers reported.

Reference

Read more of Oncology Nurse Advisor's coverage of the 2017 Oncology Nursing Society's Annual Conference by visiting the conference page.

Trends in caregiver involvement in home-based patient care are introducing new avenues for symptom management and improved health-related quality of life for patients undergoing chemotherapy for advanced breast cancer.